Gender-affirming hormone therapy is linked to lower depression in transgender adults, study shows

By Madeline Holcombe, CNN

(CNN) — Gender-affirming hormone therapy may help patients with their mental health as well as their physical bodies, according to a new study.

“Transgender, nonbinary, and gender diverse patients prescribed hormones had a 15% lower risk of moderate-to-severe depressive symptoms over 4 years of follow-up compared with those not prescribed hormones,” said lead study author Dr. Sari Reisner, associate professor of epidemiology at University of Michigan School of Public Health, in an email.

The study analyzed data of 3,592 patients of two federally qualified community health centers in Boston and New York City and looked at both their hormone therapy prescription and their Patient Health Questionnaire scores, which indicated their depression levels.

Those participants who received hormone therapy had significantly lower risks of moderate to severe depression symptoms in their four years of follow-ups, according to the study published Monday in the journal JAMA Network Open.

“When gender diverse patients access medically safe and effective hormone medication and care they are more likely to experience healthier mental health outcomes over time,” said Dr. Michelle Forcier, medical director for FOLX Health, a mental health and wellness telehealth platform for people in the LGBTQIA+ community, and clinician at TransHealth, a non-profit clinic in Florence, Massachusetts.

“Providing gender hormones did not just provide physical benefits to transgender and gender diverse patients, but yet again, we demonstrate that they improve their mental health outcomes as well,” added Forcier, who is also assistant dean of admissions at the Warren Alpert Medical School of Brown University. She was not involved in the research.

The study comes amid President Donald Trump’s executive orders that would restrict gender-affirming medical care for transgender youth, ban trans women from competing in most women’s sports and discharge transgender military members and recruits.

Depression rates higher in transgender population

Depression rates in people who are transgender, nonbinary or gender diverse are a public health crisis and need to be addressed, Reisner said.

“Trans people experience mental health disparities with higher rates of depression and suicidality than cisgender (non-transgender) people,” he added. “Trans people are literally dying. There is an urgent need — now more than ever — to care for us, support us, and ensure we have the life-saving care that we deserve and need to thrive.”

An estimated 8.3% of US adults have experienced at least one major depressive episode, according to the National Institute of Mental Health. But a 2023 study found that about 33% of transgender people showed signs of depression.

The higher rates of poorer health outcomes –– including anxiety, depression and suicidality –– in transgender people can be due to many factors, but a big contributor is the effects of bias and discrimination, Forcier said.

“Minority stress and discrimination also leads to higher risks for economic disadvantage, housing and homeless difficulties, substance use/abuse, and HIV. These cumulative disadvantages can significantly impact many aspects of physical and mental health,” she said.

Systemic problems, including stigma, attacks on civil rights and preventing access to health care exacerbates mental health challenges, added Dr. Melina Wald, a clinical psychologist at her private practice Bespoke Health in Connecticut and New York state, via email. Wald cofounded Columbia University Medical Center’s Gender and Sexuality Program.

Wald was not involved in the research.

Bills targeting medical care for transgender people have been on the rise, Reisner said.

In 2018, “2 bills were introduced and in 2023, there were 185 bills. Recent Executive Orders banning ‘gender ideology’ and restricting the rights of trans people have devastating mental health consequences for trans communities,” he added in an email.

Accessible to everyone

One strength of the study was the diversity in the ages, races, ethnicities and socioeconomic statuses of the population, Forcier said.

“This sample is much more reflective of the diversity of the US population than previous specialty clinic-based studies,” she said. “The US is an increasingly diverse population and medical studies that reflect this offer more valuable insights to care.”

The study also shows that effective hormone care might be feasible in more diverse community settings, Forcier said.

“That these patients benefited from care in these various primary care clinics in a diversity of communities suggests that effective gender affirmative hormone is no longer restricted to urban, academic, specialty clinics,” she added in an email.

Overall, the scientific literature shows that hormone therapy is safe and effective, Forcier said.

“We have more than 25 years of consistent, persistent, insistent evidence that gender affirmative approaches to care for transgender persons offer a variety of medical and mental health benefits. There are no studies that suggest that withholding medically indicated, safe, effective care (offers) any benefit at all,” she said.

That said, care for depression in the transgender population should not end at hormone therapy, Wald said.

“While gender affirming hormone therapy is crucially important to improving mental health, the importance of access to evidence-based psychiatric interventions for treatment of depression should not be overlooked,” she said. “It is a both/and approach rather than either/or.”

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